Ebola, Lassa Fever and Now Meningitis: Which Way Nigeria?

By Eric Elezuo

Though already denied, the Governor of Zamfara State, Alhaji Abubakar Yari, was quoted as saying that the diseases ravaging the Nigerian nation in recent times, most especially the northern parts, are God’s punishment on the nation for their sins.

Much as the comments are unbecoming of a leader, who should be pragmatic in find finding solutions to practical problems, most people have wondered both in their privacy and in public, saying ‘why Nigeria?’

It would be recalled that in recent years, the country has been bedeviled by a series of heart rendering diseases which have shaken the country to its foundation, and sort of attempted to make it wake up to its responsibilities.

It is not to be taken for granted that the country, like most countries of the world has at one time or another being plagued by both terminal and near terminal diseases, but the frequency with which dare-devil diseases have found succor in the Nigerian geographical entity has set mouths wagging, asking again, Why Nigeria? Is Yari right in his assessment?

As one of the 26 countries on the African “meningitis belt,”, however, Nigeria records some of the highest incidences of the disease on the continent, and justifiably so though questions are popping out wondering how much of disease prone are the other 25 countries on the same belt. The difference is the ability to take proactive steps.

Experts have argued that isn’t it proper for a country that understands its place on the so called ‘meningitis belt’ to take proper actions against any eventually, nipping it in the bud before it becomes a crisis. Nigeria did not, and today, the country is a new haven for any disease hovering around Africa, and the world in general.

In recent weeks, there has been an outbreak of cerebrospinal meningitis across 15 states of the federation. The disease is said to have claimed over 300 people in Nigeria, according to the country’s Center for Disease Control.

Consequently, an emergency response team has been sent to the five states in the northwest of the country. While about 2,000 suspected cases have been recorded, 109 have been treated since the outbreak began in February.

The meningitis is a disease which peaks in the dry season in certain states due to the low humidity and dusty conditions and usually end as the rainy season approaches, according medical experts.

“Meningitis is a tough disease, especially during this period, and it is associated with overcrowding, understanding the living conditions in the country, people must keep their building ventilated,” said a health official.

The World Health Organisation (WHO), in its report, said that even when the disease is diagnosed early and adequate treatment begins, 5% to 10% of patients die, typically within 24 to 48 hours of the onset of symptoms. That is how serious the disease is.

Some common symptoms are stiff neck, high fever, sensitivity to light, confusion, headaches and vomiting.

Local and international organizations are working together to manage the epidemic. “We believe that our concerted efforts will bring this outbreak under control, as we also work towards preventing outbreaks of this scale in the future,” the Center for Disease Control stated warning that there were not enough vaccines against it.

Chief Executive Officer of the Centre, Chikwe Ihekweazu said: “There is a vaccine available, but it is not commercially available for the stereotype involved in this specific outbreak, and we have to make application to the World Health Organization for the vaccines.”

However, in a press release, Health Minister, Professor Isaac Adewole, said that up to 1.3 million vaccines have now been acquired.

“We have secured 500,000 doses of the meningococcal vaccines from WHO which will be used in Zamfara and Katsina states,” Prof. Adewole said. “While additional 800,000 units from the British government.”

In the light of the above, health workers had began a mass vaccination programme to try to halt the mass outbreak.

In another report, the Nigeria Centre for Disease Control (NCDC) said there had been 2,997 suspected cases of the disease in 16 states as of April 3, with 336 deaths.

“Right now, vaccinators are in the field in Zamfara state administering doses of vaccine to contain the spread of the disease,” Lawal Bakare, from the agency, told AFP.

Zamfara, in northwest Nigeria, and the neighbouring states of Sokoto, Katsina, Kebbi and Niger have been hit hardest by the disease which broke out in November. Most of the dead are children aged five to 14.

Meningitis is caused by different types of bacteria, six of which can cause epidemics. It is transmitted between people through coughs and sneezes, and facilitated by cramped living conditions and close contact.

The illness causes acute inflammation of the outer layers of the brain and spinal cord, with the most common symptoms being fever, headache and neck stiffness.

Nigeria lies in the so-called “meningitis belt” of sub-Saharan Africa, stretching from Senegal in the west to Ethiopia in the east, where outbreaks of the disease are a regular occurrence.

The country and neighbouring Niger were both badly hit by meningitis outbreaks in 2015, when over 13,700 people were infected in six months, with more than 1,100 deaths.

The Federal Ministry of Health has issued public advisory warning to Nigerians as the number of deaths associated with cerebrospinal meningitis outbreak rises to 328 in 90 Local Government Areas in 16 states including Zamfara, Katsina, Sokoto, Kebbi, Niger, Nassarawa, Jigawa, FCT, Gombe, Taraba , Yobe, Kano, Osun, Cross Rivers, Lagos and Plateau.

In curtailing the scourge, Prof Isaac Adewole, disclosed as follows:
“We have started working with all the affected states in specific areas of collaboration on massive awareness and sensitization, laboratory investigation and analysis, proper documentation and disease surveillance techniques through the National Centre for Disease Control and National Primary Health Care Development Authority (NPHCDA) who have been of tremendous support since the outbreak. We are in constant discussion with World Health Organization (WHO), UNICEF, E-health Africa and other international health agencies for supplies of vaccines and injections.

“Through our initiatives, we have secured 500,000 doses of the meningococcal vaccines from WHO which will be used in Zamfara and Katsina states while additional 800,000 units from the British government .By next Tuesday, there will be a meeting with the International Review Group of The World Health Organization (WHO) where request for additional vaccines shall be approved, as part of practical and medically certified efforts to stem this ugly incidence.

“Even with the tunnels of accomplishment made, we are not relenting on all the progress made, as we have been assured of millions of vaccine doses through other notable and international donor agencies. Unfortunately, Nigeria had always been bedevilled with the stereotype A in years past but this new strain of the bacterial disease, Meningitis Stereotype C which the vaccine is not commercially available in required quantities and can only be shipped to the country by WHO only if laboratory investigation confirms the existence of the strain type C.

“Our ongoing spirited effort is geared to upscale through nationwide immunisation campaign while navigating the menace using a combination vaccine by conducting active case finding, strengthening surveillance, case detection, verification and communication management, performing lumbar puncture of suspect cases in a well coordinated atmosphere under NCDC. Our partners are already re-training physicians on the effective collection of cerebrospinal fluid for diagnosis.

“We are equally advocating for prompt diagnosis and have issued directive to all Federal medical facilities and PHCs to treat all cases of meningitis free of charge. All Nigerians especially residents of Katsina, Kano, Kebbi, Sokoto, Niger, Zamfara and Jigawa states are advised to seek early attention when discomforted with symptoms of Cerebro Spinal Meningitis (CSM) and avoid clogging together in unventilated and over-crowded rooms.”

Ebola

The earliest of Nigeria’s known great diseases broke out on July 20, 2014, when an acutely ill traveler from Liberia arrived at the international airport in Lagos, Nigeria, and was confirmed to have Ebola virus disease (Ebola) after being admitted to a private hospital. This index patient, according to reports, potentially exposed 72 persons at the airport and the hospital.

The Federal Ministry of Health, with guidance from the Nigeria Centre for Disease Control (NCDC), declared an Ebola emergency.

On July 23, the Federal Ministry of Health, with the Lagos State government and international partners, activated an Ebola Incident Management Center as a precursor to the current Emergency Operations Center (EOC) to rapidly respond to this outbreak. The index patient died on July 25; as of September 24, there were 19 laboratory-confirmed Ebola cases and one probable case in two states, with 894 contacts identified and followed during the response. Eleven patients with laboratory-confirmed Ebola were discharged, an additional patient was diagnosed at convalescent stage, and eight patients died (seven with confirmed Ebola; one probable).

Obviously, the nation contained the disease with Onyebuchi Chukwu as the then Minister of Health and Jide Idris as the Commissioner for Health in Lagos State, prompting a contest among politicians about which party tackled the menace since the Federal and Lagos were controlled by different political parties. No one is permitted to blame the country on this one though a lot of porosity prompted the index, Sawyerr to arrive the shores of Nigeria.

Several issues were observed by the response team during Nigeria’s Ebola outbreak that could, in retrospect, have been mitigated through additional preparedness planning for public health emergencies. First, financial resources were slow to arrive at the EOC, a delay that threatened to impede the rapid expansion of containment activities across the response. Early activities were funded by the Lagos State government, international partners, and nongovernmental organizations. National preparedness efforts should consider how resources can be quickly accessible to fund the early stage of the response. Second, there were discrepancies among the levels of political leadership in fully appreciating the enormous consequences that even a small Ebola outbreak could have on civil institutions such as hospitals, airports, and public gatherings.

The following were given credit for curtailing the disease: Onyebuchi Chukwu, MD, Jide Idris, MD, the Ebola EOC response team in Nigeria, Alex-Okoh, MD, Chima Ohuabunwo, MD, Ndadilnasiya Endie Waziri, MD. Andrea Carcelen, MPH, Lisa Esapa, MPH, Deborah Hastings, MD.

However, Dr. Stella Adedevoh was the hero of the period as she single handedly prevented the disease from spreading beyond where it was discovered. She however, did this at the expense of her life.

Hardly had the Ebola disease cleared out did another menace crept in. it was Lassa Fever; an acute viral haemorrhagic fever, extremely virulent and often infectious, which occurs very frequently in different parts of Nigeria and affects approximately 100,000-500,000 persons per year in West Africa. The illness was discovered in Lassa, Borno State where it was first reported, and where it took its name. It is caused by the Lassa fever virus, a single stranded RNA virus belonging to the arenaviridae family. In more explicit terms, it is caused by rodents such as rats.

The incubation period for Lassa fever varies from 6 – 21 days. It is symptomatic and usually characterized by fever, myalgia, nausea, vomiting, sore throat, abdominal and chest pains. Illness may progress to more serious symptoms including haemorrhaging, neurological problems, hearing loss, tremors and encephalitis.

There have been several Lassa fever outbreaks since it was first reported in 1969 with the worst outbreak recorded in 2012 where 623 cases including 70 deaths were reported from 19 out of the 36 states. In 2016, cases were reported in seventeen states with 212 suspected cases and 63 deaths. Case fatality rate has been put at 37.9%.

Nigeria obviously battled the worst outbreak of Lassa fever in history, as it afflicted over 284, killed about 154 Nigerians from different parts of the country from August 2015 even as fresh cases being recorded in some states like Ondo and Bauchi, where the outbreak had earlier stopped.

Health watchers noted that unlike the response to Ebola outbreak, government may have failed to do same to Lassa. Rather, the outbreak was greeted with the attitude of complacency. For instance, the Minister of Health, Prof Isaac Adewole, while speaking to State House Correspondents in Abuja said Nigeria cannot win the battle against Lassa the same way it won the battle against Ebola because Lassa is endemic in Nigeria.

He however, made a statement that Nigerians wish to take to the bank: “I call it an embarrassment because as a nation we cannot witness Lassa fever every year; it is rather abnormal for a nation that has resources like we should have to be witnessing such epidemic.”

“The minister understood that the reason for the embarrassment is the nation’s inability to put their best foot forward, inability to plan ahead and much more,” said a director in Ministry of Health, who prefers anonymity.

To another stakeholder, a renowned Professor of Pharmacognosy and President, Bioresources Development Group, Prof. Maurice Iwu, Lassa was more than an embarrassment because the country has the personnel required, knowledge of the fever and how to prevent it, but the disease still claims lives.

“As long as Lassa fever is anywhere in the country, as long as we have restaurants that don’t keep good hygiene, as long as we have houses that are co-infested with rat and horse, as long as we have dirty environment, we are all vulnerable,” he said.

“The only thing we can do is keep track of the virus, and from time to time do research. Our universities should make sure that 80 percent of their research is localized to treat our own diseases, issues and viruses we live with,” he added.

It appears that from the foregoing, the diseases come and go on their own, with very little effort put in to eradicate it.

We only try to manage, not eradicate, and that is why the diseases resurrect within a define time. We need people who can think ahead; people who holds solution, not a group of hurriedly assembled individuals who want to manage a crisis,” a health worker noted.

Time has come when the leaders should do all within their power to make the country unattractive to every yamma yamma sickness around the corner.